Prolonged delay for controlling KPC-2–producing Klebsiella pneumoniae outbreak: The role of clinical management

Delory, Tristan; Seringe, Elise; Antoniotti, G.; Nováková, I.R.O.; Goulenok, Cyril; Paysant, I.; Boyer, Sylvie; Carbonne, A.; Naas, Thierry; Astagneau, Pascal

doi:10.1016/j.ajic.2015.05.021

Cited by 13 publications

(13 citation statements)

References 26 publications

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“…to link episodes within the appropriate serial interval rather than “siblings” from the same infector episode). This baseline window was consistent with French epidemiological data on observed delays before detection of CPE cases within a hospital following transfer of colonized patients 21 , 22 . It was also supported by the sensitivity analysis results where we observed that, among all windows, it provided one of the lowest observed mean distance as well as one the largest difference from the permutations in 2015 (Supplement 3 ).…”

Section: Discussionsupporting

confidence: 89%

“…In a multi-hospital outbreak of carbapenemase-producing Klebsiella pneumoniae (KPC), two patient contacts were transferred and detected positive in two other hospital facilities 15 and 29 days after the detection of the hospital index cases 21 . In another KPC outbreak, following patient transfers out of the hospital in which the outbreak originated, KPC colonization was detected in two other hospitals respectively 19 and 25 days after detection of the index case in the original hospital 22 .…”

Section: Methodsmentioning

confidence: 99%

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Assessing the role of inter-facility patient transfer in the spread of carbapenemase-producing Enterobacteriaceae: the case of France between 2012 and 2015

Nekkab

Crépey

Astagneau

et al. 2020

Sci Rep

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The spread of carbapenemase-producing Enterobacteriaceae (CPE) in healthcare settings is a major public health threat that has been associated with cross-border and local patient transfers between healthcare facilities. Since the impact of transfers on spread may vary, our study aimed to assess the contribution of a patient transfer network on CPE incidence and spread at a countrywide level, with a case study of France from 2012 to 2015. Our results suggest a transition in 2013 from a CPE epidemic sustained by internationally imported episodes to an epidemic sustained by local transmission events through patient transfers. Incident episodes tend to occur within close spatial distance of their potential infector. We also observe an increasing frequency of multiple spreading events, originating from a limited number of regional hubs. Consequently, coordinated prevention and infection control strategies should focus on transfers of carriers of CPE to reduce regional and inter-regional transmission.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Assessing the role of inter-facility patient transfer in the spread of carbapenemase-producing Enterobacteriaceae: the case of France between 2012 and 2015

Nekkab

Crépey

Astagneau

et al. 2020

Sci Rep

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“…2 The nature of plasmid-mediated carbapenemases such as class A enzymes of the KPC type, zinc-dependent class B metalloβ-lactamases of mainly NDM, IMP, and VIM types, and class D carbapenemase of OXA-48 type facilitates global transmission and causes numerous outbreaks of CPE in the healthcare settings. [3][4][5] Failure in recognizing asymptomatic carriers may result in nosocomial transmission 6 or even country-wide outbreak. 7 Therefore, enhanced infection control measures such as active surveillance, isolation and cohorting of CPE patients with dedicated nursing staff and medical equipment, and daily bathing with chlorhexidine gluconate have been implemented to control the spread of CPE in the endemic settings.…”

mentioning

confidence: 99%

A Novel Risk Factor Associated With Colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in Addition to Antimicrobial Treatment

Cheng

Chen

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).METHODSWe analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.RESULTSOf 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).CONCLUSIONSConcomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.Infect Control Hosp Epidemiol 2016;1418–1425

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“…Healthcare-associated outbreaks of multidrug-resistant gram-negative organisms are well documented [53,59,60]. The establishment of an outbreak management team provides best practice for responding to CPE within a health facility [4,13,26,58]. An outbreak management team may be activated at the discretion of the relevant lead within the health facility.…”

Section: Rationale and Commentarymentioning

confidence: 99%

“…An outbreak management team should be established, led by a health facility executive, with representatives from bed management, infection prevention and control, infectious diseases and/or microbiology, unit/unit manager(s), relevant clinical team(s), and cleaning/environmental services[1,13,41,58]. 4.1.4 The CPE action plan developed as part of the outbreak action plan should be implemented (see Recommendation 1.1.4), including the use of contact precautions for all suspected or confirmed cases of CPE (see Recommendation 3.1.1), monitoring of compliance of the health workforce with contact precautions and provision of feedback (see Recommendation 3.1.3).…”

mentioning

confidence: 99%

Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities

Richards¹,

Cruickshank²,

Cheng³

et al. 2017

Infection, Disease & Health

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Gram-negative bacteria that are resistant to antimicrobials, including carbapenems, have emerged as a significant global public health threat. Multidrug-resistant gram-negative bacteria, including carbapenemase-producing Enterobacteriaceae (CPE), place patients at risk of potentially untreatable infection. Australia has not reported a large number of CPE cases compared to Europe, North America, and the Middle East, creating an opportunity to prevent CPE from becoming established in Australia.An outbreak of Klebsiella pneumoniae carbapenemase in 2014 demonstrated there was variable testing, reporting, response to and communication of CPE. In response, the Australian Commission on Safety and Quality in Health Care formed a taskforce to assist health facilities to respond to the threat of CPE. Recommendations for state and territory health departments include coordinating a risk assessment, undertaking epidemiological and microbiological investigations, determining the requirement for control measures, and coordinating risk-communication activities. The response should take advice from experts in infectious diseases, microbiology, public health, infection prevention and control and epidemiologists.The guide aims to: Alert healthcare professionals, health departments and hospital executives to the emerging threat of CPE in Australia Recommend strategies to prevent, detect and contain CPE Provide information and resources for hospital executives, healthcare professionals and consumers Recommend laboratory screening and confirmation methods.The recommendations with rationale and commentary have been structured into sections depending on the burden of CPE in the health facility. The sections include: planning, preparing and prevention; CPE screening and surveillance; strategies to reduce CPE transmission; outbreak management; laboratory screening and confirmation methods.

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Prolonged delay for controlling KPC-2–producing Klebsiella pneumoniae outbreak: The role of clinical management

Cited by 13 publications

References 26 publications

Assessing the role of inter-facility patient transfer in the spread of carbapenemase-producing Enterobacteriaceae: the case of France between 2012 and 2015

Assessing the role of inter-facility patient transfer in the spread of carbapenemase-producing Enterobacteriaceae: the case of France between 2012 and 2015

A Novel Risk Factor Associated With Colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in Addition to Antimicrobial Treatment

Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities

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